While differentiating the forms of the outcomes, the study found psychotic form of residual condition in 9.5%, the form with reduced positive symptoms in 35.8%, deficit form in 42.0% and outcome in the form of clinical recovery in 12.8% of the investigated cases. The form of clinical recovery of residual phase was presented with the most expressed regredient course of the schizophrenia after the long-term episodes of psychosis and rapid progredient course of the disease followed by the development of the residual phase of schizophrenia.

To the issue of diagnostics of combined forms of mental diseases

B.N.Piven, O.S.Bulat, L.V.Leshchenko (Barnaul)

Analysis of medical documentation of 414 mental patients treated during one year in two psychiatric inpatient departments as well as 434 outpatients with schizophrenia revealed high prevalence rate of combined forms of mental disorders. On the other hand, analysis of the verbatim transcripts of the clinical case conferences published in the Independent Psychiatric Journal in 2008-2011 demonstrated lack of positive attitude from the part of physicians with regard to identification of combined psychiatric pathology, and its inadequate detection in everyday clinical practice. The facts that combined mental disorders didn’t find their adequate representation in psychiatric textbooks and that ICD-10 considers such disorders as something insignificant contribute to the problem. Meanwhile, such an attitude of the physicians reduces the efficacy of psychiatric service.

Key words: combined, comorbid, mental, disorder, case, conference

Panic Disorder with Agoraphobia: Diagnostic Issues and Comorbidity

A.V.Pavlichenko, D.A.Chugunov

We have sorted out 59 inpatients with the diagnosis of “Panic Disorder” according to the DSM-IV criteria for PD. The research was naturalistic follow-up. We investigated the course of illness during relapses leading to subsequent hospitalizations or to outpatient treatment.

Age of onset for PD was 36,5 ±10,8 years. Dynamics of PD was either episodic (33,9%) or chronic but waving (66,1%). It has been identified three phases of the course of PD. First phase (0-3 years after first episode of illness) was characterized by situationally predisposed Panic Attacks (PA) that were accompanied not only by somatic and cognitive symptoms, but also conversion signs (30,5%) and social phobias (10,2%). In most cases (81,4%) it led to avoidance of travelling alone on public transport, illness phobia (54,2%), subclinical generalized anxiety disorder (37,3%) and subclinical secondary depression (27,1%). Coping strategies included the travelling with only relatives and taking drugs or drinking during PA. In the second phase (an average of 2-5 after onset of PD) individuals experienced significant agoraphobic avoidance even driving and being alone outside the home. Spontaneous PA were accompanied by only somatic and conversion symptoms. Comorbid disorders included somatoform disorders (30,5%), generalized anxiety disorder (27,1%) and alcohol abuse (20,3%). Avoiding going out alone and dependence on relatives had prevailed among the coping strategies. Limited symptom attacks and decrease in agoraphobic avoidance have been associated with the third or residual phase (4 years or more after manifestation of PD). The most common patterns of comorbidity were OCD (aggressive impulses, pathological doubts) - 15,3%, personality disorders (dependent and histrionic)-11,8% and major depression (10,1%). Coping strategies were dependent on certain comorbid conditions. Histrionic personality disorder was accompanied by desire to get the disability benefits, pathological doubts -with checking and rechecking and dependent personality disorders – with overprotection and dominance from others. The favorable prognosis of PD has been associated with the development of first PA following exposure to a stressful event, the presence of only somatic symptoms during PA, absence of agoraphobia, late age of onset and generalized anxiety disorder as only comorbid condition. Symptoms of poor prognosis were the following: absence of any situational triggers before manifestation of PA, the presence of depersonalization and fear of losing control during PA, significant agoraphobic avoidance, OCD and histrionic personality disorder as comorbid conditions.

In conclusion, our prospective follow-up research has revealed the natural course of PD from full-blown PA - through agoraphobia - to limited symptom attacks and the direction of associations between PD and comorbid conditions. That PD, agoraphobia, illness phobia and generalized anxiety disorder frequently occur together suggests their coexistence is not due to chance, and may represent a specific syndrome having an important diagnostic value.

Тo a problem of neuroleptic malignant syndrome

V.P.Volkov

Patient's records of the Tver regional clinical mental hospital No. 1 and literary data about such rare, but potentially life-threatening condition as neuroleptic malignant syndrome (39 own and 50 literary cases) were studied by means of statistical method. The purpose of this work is to characterize the major clinical manifestations of this disease, to clarify their frequency and to allocate indicators which are the most informative for the diagnosis. Higher awareness on NMS guarantees its early diagnostics and the correct treatment and warns a deadly outcome.

Psychiatric inpatients: their needs and satisfaction of mental health care

E.B. Lyubov and the Investigation Group

Review of 378 psychiatric inpatients stressed the need to improve the tolerability and effectiveness of pharmacotherapy as well as the need to the target psychosocial work.

Key words: psychiatric inpatients, needs

Independence of an expert: Position of the European Court of Human Rights

Yu.N.Argunova

The analysis of legislative regulations establishing the principle of expert’s independence is given and flaws in its formulation are revealed. The author examines the ECHR’s decision of 11.12. 2008 in Shulepova v. Russian Federation. Some measures on improvement of legislation and law enforcement, and expert practice are proposed.

Key words: forensic psychiatric, examination, independence of expert

The Right of the citizens to obtain information about their health may be found under threat of violation

A.G.Ustinov

Legal-technical analysis of the article 22 of the Federal Law of November 22, 2011, # 323 FL “On the Principles of the Health Safety of the Citizens in the Russian Federation” is conducted, and the need of introduction of changes in mentioned article is justified. The author draws attention to the necessity of speedy adoption by the Ministry of Health of the Russian Federation of the normative legal act establishing grounds, procedure and time frame for granting medical documents (their copies) and excerpts from them.

Key words: information on a state of health, medical documents, patient

Individual and group psychotherapy was used for outpatients and inpatients of Mental Hospital №1. Schizophrenic patients prevailed. The succeeded aims: attraction of patients with negative and positive disorders; creation of psychotherapeutic environment; appeal to each patient's personality; training of subject-subject communications and cooperative work practice.